The present invention relates to a tracheotomy endotracheal tube useful for delivering oxygen and anesthetic gases to a patient undergoing surgery. More particularly, the invention relates to a flexible tracheotomy endotracheal tube comprising a short distal section of tubing and an integrated cuff, a long proximal section of tubing, and an intermediate section of tubing connecting the distal and proximal sections through bends forming specified angles between the sections.
General anesthesia requires the delivery of oxygen and anesthetic gases to a patient's lungs during surgery. This may be done using a facemask, a laryngeal mask airway, or an endotracheal tube. Endotracheal tubes are available from several manufacturers, and in several styles. The tube may be cuffed or uncuffed. An inflated cuff allows a paralyzed patient to be ventilated with positive pressure without the air leaking back out the mouth. The tube may be straight or have a pre-formed bend to allow accurate placement of the tube without having to carefully measure its length below the vocal cords. A pre-formed bent tube is called an RAE tube. Both oral and nasal RAE tubes are available.
U.S. Pat. No. 3,964,488, Ring et al., issued Jun. 22, 1976, discloses a pre-formed, oral or nasal endotracheal tube made of flexible material having a memory such that the tube will return to its pre-formed shape following flexure. The endotracheal tube has distal and intermediate sections that merge with each other along the length of the tube, a proximal section that is substantially rectilinear, and an abrupt bend portion between the proximal and intermediate sections of the tube that forms an angle substantially no greater than ninety degrees.
U.S. Pat. No. 4,987,895, Heimlich, issued Jan. 29, 1991, discloses a cuffed tracheal tube that accommodates and follows the axial lengthening, shortening and translating movement of the trachea in actions such as breathing and swallowing. This minimizes relative movement between the trachea and the tube where the tube inner end engages and bears against the trachea.
While these and other endotracheal tubes are known in the art, administering anesthesia to patients via a tracheotomy, whether temporary or permanent, can still pose particular problems. Uncuffed tubes are prone to leak with positive pressure, especially if the diameter of the actual stoma is smaller than the diameter of the trachea. Straight endotracheal tubes get in the way if operating on the head and neck, and may kink if bent out of the way. Armored tubes do not kink but can be difficult to bend out of the way. Standard RAE tubes often are too long and need to be trimmed so they do not lie in a bronchus. A trimmed oral RAE tube is often used to deliver anesthesia to a patient with a tracheotomy, but it typically does not contain a cuff since any cuff would be cut off during trimming of the tube. Such a trimmed oral RAE tube may thus leak if the size of the stoma is smaller than the size of the trachea. Finally, the connection between the anesthetic tubing and the trimmed RAE tube generally lies on the patient's chest under surgical drapes, where it is difficult for the anesthesiologist to access.
Thus, there is a need for a tracheotomy endotracheal tube suitable for delivery of oxygen and anesthetic gases to a patient's lungs, which tube does not lie in a bronchus, does not leak during positive pressure ventilation, does not get in the way during surgery on the head and neck, and is readily accessible to the anesthesiologist.